I am reluctant to write this post. I’m sure I’m going to make a few people mad. In last month’s Connectors Meeting there were questions about how different diet types contribute to mental health concerns. When a person's diet choice restricts food categories, they can find over time that their diet is contributing to increased anxiety and depression. This is because a diet that limits food groups can lead to nutrient deficiencies if health metrics are not carefully monitored through diagnostic labs.

In this post I’ll review some things to watch out for when eating significant amounts of highly processed foods, following vegetarian or vegan diets, and keto/paleo/Atikins types of diets.

Highly Processed Food Diets

Diets high in processed foods have been shown to increase depression and anxiety. These are diets with lots of white foods (bread, rice, potatoes, pasta, muffins, bagels, chips, sweets, fast food). With this diet, when I look at an individual's labs what I typically see are deficiencies in nutrients that help to synthesize dopamine and serotonin. Common deficiencies are protein, B vitamins, magnesium, zinc, omega 3, Vitamin D3, and fiber. Additionally, there is increased inflammation as indicated by elevated C-reactive protein (CRP) levels. Inflammation contributes to depression, fatigue, bipolar, cardiovascular disease, dementia, and diabetes, to name a few concerns. Dr. Felice Jacka provides a whole body of research about the impact of diet on mental health. Here is her seminal paper: Association of Western and traditional diets with depression and anxiety in women.

Vegetarian/Vegan

When I see vegetarians and vegans in my office, they tend to be very anxious individuals and the anxiety often leads to depression. I’m not saying that all vegetarians and vegans struggle with anxiety and depression. Rather, that individuals who are anxious and depressed and vegetarian tend to have higher levels of anxiety and depression due to nutrient deficiencies. Their anxiety is often caused by fluctuations in blood sugar levels because of the low carbohydrate to protein ratio in many of the foods they typically consume.

For example, let’s consider a bean burger. Beans have some protein and some carbohydrates. The bread is all carbohydrates. So this bean burgers contain a lot of carbs and not a lot of protein

Clinically, I have seen anxiety decrease significantly when we assure that they are getting enough protein throughout the day (8 grams per 20 pounds of body weight or at least 65 grams divided throughout the day for anyone over 140 lbs.)

There is a large body of research that suggests vegetarians have better physical health then omnivores. Vegetarians tend to have lower body mass index and cardiovascular disease. However, an Australian study with 9113 participants indicated that vegetarians and vegans have more anxiety and depression then omnivores.

For vegetarians, the labs that I carefully look at are total protein, Omega 3, ferritin (iron stores), B vitamins, and Vitamin D3. In my client base, vegetarians and vegans tend to carry less muscle mass and more fat mass.

For vegans, I will also look to see what their primary sources of fats are. The addition of coconut milk and oil can help with fatigue caused by a lack of cholesterol in their diet; consuming enough cholesterol is important because it helps synthesize hormones.

Keto/Paleo/Atkins

I am going to make a “no duh” statement… But it’s one we often forget: Weight does not determine health.

High-fat mass can impact health, but it’s not everything. I’m far more concerned about an individual's ability to be self-compassionate, eat primarily health-sustaining foods, engage in some level of regular movement or exercise, sleep well, and have healthy labs.

I have seen a number of individuals who started on a keto diet (low carbohydrate with high protein and high fat) to lose weight. However, after the initiation phase of just meat and fat, they did not add fruits or veggies back into their diets for years. They explain that primary reason for staying with this phase is because adding back fruits and veggies caused them to gain back the weight they had lost. This is true, because when we do quick weight loss programs it’s hard to not do quick weight gain as well. However, there are some serious health consequences not eating fruits and vegetables.

One of the consequences is that they became very low in B vitamins and Vitamin K. For women following this type of dietary restrictions, they started having heavy menses because their blood was not clotting well. This then also led to iron deficiency, which contributed to their story of depression/fatigue.

In conclusion

Diets that support physical health do not always support mental health. Diets that are low in nutrient dense foods can contribute to mental health concerns through presentation of depression/fatigue and hypoglycemia/anxiety. When someone is considering medications or has tried medicines without the expected positive impact, it’s worth suggesting that they ask their primary care providers for a laboratory workup for fatigue. Going to a naturopathic physician, nutritionist, or acupuncturist to have their diet evaluated for deficiencies that could be contributing to their mental health status is also a good option.

In 2018, my blog focused primarily on anxiety. This year I am thinking more about movement and mental health. A good starting place is identifying the minimal metrics for movement and how achieving these metrics can support mental health.

So, I spent some time reviewing the most recent studies for exercise.

What is definitive?

Exercise reduces dementia and reduces all causes of death. For mental health in general, cognitive functioning exercises in studies don’t always show that it is helpful. They have not shown that they decline cognitive functioning. Ok. Exercise dose not always helps to be smarter. But for depression, the research is clear: exercise is an excellent therapy on its own and in conjunction with other therapies. Exercise increases neuroplasticity, improves how the autonomic and endocrine systems respond to stress, improves sleep, improves self-esteem, …the list goes on. So, we can definitely say now that exercise is good for both the brain and body.

How much movement do the studies say is needed?

When people exercise three times a week for 12 to 24 weeks, there is a dramatic reduction of depression, and if the exercise continues, there is a reduction in recurrence. That sounds great! And… those people were selected and paid to be in the studies.

Beyond the studies and in my office

When people can feel that movement improves how they feel, then it becomes a useful tool for treating energy and mental clarity in the moment. I believe that part of treating depression, mental health, pain, and other diseased states, is to provide people with tools that move them towards resilience moment to moment. If a person has a tool that can help them feel better now, today, or later today, we can build experiences that move us away from depression, fatigue, low self-esteem, anxiety, pain, or whatever their points of suffering are. Why does this work? When people can experience change that they are in control of, and learn the value of the process, they have a model of change that can then apply to other things in their life.

But how do you actually get someone who is depressed moving?

At my last PESI training in Richmond, VA, I posed this question to the group of around 90. I like to start with the smallest possible metric, in large part because it is doable. And since I am all about being able to feel what’s going on in the body, I first asked everyone to do an experiment. You, the reader, can do the same experiment now.

The Minimal Movement Experiment

1. Check-in and rate your energy level at this moment, using the scale below.

Chair squats – have a chair behind you and sit down as though you are going to take a seat. Just as the chair touches you, stand back up;

March in place – with your knees coming up as high as it is comfortable; or

Overhead hand clap – raise both arms in the air and bring your hands together comfortably over your head. Clap your hands together if that sounds like fun.

Remember one of these, just four times.

3. Sit back down and re-rate your energy level.

The majority of people in my training reported feeling at least 10% better. So, if you were initially at 6 (out of 10), you might now be at 7… in less than 30 seconds! What could you do with 10% more energy? Do you get up to snack or drink coffee at work when you might just need to move your body a little bit to get some energy and mental clarity?

Where can the experiment be done?

Certainly, YOU can do this experiment anywhere: at the office, in the bathroom, when you get off the couch from watching TV. Additionally, you can try this experiment with clients who present with fatigue or who are kinesics learners. I offer it as a mindfulness exercise for people with childhood history of trauma, as a way got them to learn to listen to their bodies. It is a small enough dose that it is unlikely to make fatigue worse. Maybe nothing is noticed, but they tried something new. I also like to give it to my clients as homework (“Since the exercise was helpful in my office, I would like you to try it when you have been sitting for more than three hours.”)

Throughout the year, I will write more about how to use movement as a way to improve energy and mental clarity.

For years, I had a consistent dream of a bear chasing me. I would wake with my heart racing. I didn’t want to go back to sleep for fear of the bear returning.

How do I fix a problem when I am not even conscious for the event? I started to look for patterns.

I noticed that when I went out with friends and had a drink with dinner, the bear would predictably visit. I noticed that when I had a late dinner with lots of protein and no alcohol, the bear was absent. I moved into a new apartment in the summer and it was hot, so I left the bedroom door open for a cross breeze. No bear. It cooled down and I closed the bedroom door while I slept…bear. Open door, less likely bear. I started a list of what seemed to make a difference. Open door, protein at night, limit alcohol at night: the bear dream was more manageable.

I started seeing a therapist to address some anxiety about being dyslexic and in medical school. When my therapist showed me how turn into my anxiety instead of trying to ignore it or avoid it, my dream changed. One night, instead of running from the bear, I turned to face it and said “What?!” The bear just stopped and sat down in front of me. I had a sense that I had found a new best friend. Now, I can trust my anxiety to tell me when something is off, and I can look with curiosity until I understand my discomfort.

Later as I started to study the physiology of mental health and how the brain works, I could see why my observations helped. Not getting random hits of adrenaline due to dropping blood glucose from alcohol or not eating protein is helpful.

We all have ancient brains that will scan our environment for safety and make sure we are not being approach by lions (or bears). We all need to figure out what our bodies and brains need to feel safe., especially while asleep. Nightmares and night waking are a chance to listen deeply for what we need, observe our patterns, and do experiments to learn more about what the body and brain need. Please read the Short Cuts post for more ideas about how to improve sleep.

There is a spectrum of sleep disturbances that can affect us: such as nightmares, anxiety dreams, sleep terrors, fitful sleeping, awake in the early morning for two hours (“3AM Committee Meetings"). If you suffer from having your brain wake you up or sleep through horrible stories, you may have tried various prescription medications only to find that maybe you don’t remember not sleeping well but still feel tired and groggy.

I suggest trying an experiment to prevent hypoglycemia and keep you brain oriented to the safety of today. This might help you reduce your medications or prevent the use of medications.

Let’s create check list of things that are likely to decrease sleep disturbances:

Go to bed at about the same time every night and wake at about the same time every morning.

Sleep in a relatively quiet space

Sleep in relative darkness

Turn off screens one hour before bed

Have any alcohol and dessert shortly after dinner, not on its own away from a meal

Have a consistent ritual to indicate that it is time for sleep (drink a cup of herbal tea, take a bath, read a book, play a game of cards…whatever works for you).

If the above list is basically being adhered to and sleep disturbances still occur, try the following experiments:

Eat protein before bed, such as a piece of turkey or a couple spoonful’s of cottage cheese. This will stabilize your blood sugar. One cause of sleep disturbances is dropping blood glucose and the resulting sudden release of adrenaline.

Have a Lizard Brain Treat ready: a ¼ cup of juice and one handful of nuts will often help you get back to sleep within 30 minutes rather than 2 hours. For early morning nightmares, if they are consistent, and you wake to go to the bathroom, have the juice and nuts - this will keep your blood glucose up and prevent an adrenaline release by keeping your brain fueled. Try this for at least 5 to 7 days to see if it works.

Work with a therapist to address how you understand anxiety and any past trauma.

Create cues of safety during sleep. The problem and blessing of sleep is that you are not time oriented. In your brain, the past can be present and the future can be worried about. Historic memories can replay past trauma or only parts of past trauma, such as the emotions, the sounds, or the sensations. Creating a sensory experience that your brain can monitor will help indicate that it is the present moment and safety is being sustained through the night can help. This takes a little internal work to overcome what your “rational brain” will say. I have clients who just keep asking “what do I need to feel safe while sleeping?” Some women have put a lock on their bedroom door even though the house is locked and they have a large dog. One person tied a string to the door of the bedroom and to a vase that would break and wake them up. Sometimes it just helps to take a flat sheet and wrap yourself in a cocoon. Playing sounds of the ocean might help.

Sleep patterns are challenging to change because for the most part our conscious observer mind is asleep and is only receiving partial information. So when deciding to do a sleep experiment be sure to try it for at least 5 to 7 days. If the experiment works, try to be consistent for at least 6 months to rewire the new sleep habit.

The other night I went to a showing of CrazyWise, the documentary by Phil Borges and Kevin Tomlinson. They examined the question of why the recovery rate for mental illness in industrial countries is one third, and in developing countries two thirds? Think about that for a moment. All our medications and skilled providers plus billions of dollars is not working!

Often what we see in the US as mental illness, such as depression, anxiety, or hearing voices, is seen as a calling in other countries - an experience to learn more about yourself. It might mean that you will become a healer because to understand yourself you have to understand the fundamental nature of being human. Within the countries with higher recovery success rates, the people in the person's community will connect with them. Again, let’s think about this for a moment, when a person is struggling their community comes together or someone experienced wants to be curious with that person about what they might need to understand about their self. They offer connection and compassion.

Part of the problem in the western world is that we are in denial about the prevalence of Adverse Childhood Events (ACE). In some communities, it's above 50%. An adverse childhood event is an event that is beyond the comprehension of a child (abuse, neglect, divorce, illness, addiction). Really these are beyond the comprehension of adults as well, but for children, it threatens their nervous system in a way that can set a person up for mental illness, addictions, and physical health challenges such as diabetes, obesity, and cardiovascular disease.

What I loved about CrazyWise is that the movie is not saying that medications are bad. They are suggesting that the path forward is connection. Rather than labeling someone in crisis as ill, let’s think about how to get that individual more connected. Evidence-based studies are showing that community helps with addictions, psychotic episodes, homelessness, depression, anxiety, and the list continues.

The path away from mental illness is connection: how we each connect to our bodies, ourselves, other people, and nature.

As an experiment, think about what your connections are. Can you draw a map of your connections? Maybe a thin line for loose connections and a think line for strong connections. Are they all people? What about animals, plants, places, food, activities, art, crafts, books, communities... Where do you put our energy and where do you receive our energy?

In a life long ago and far away in Vermont, I worked in a hospital diversion program for adolescents. We worked with kids who were suicidal, homicidal, had turned to self-harm behaviors to cope with chaos, and addiction. Our job was to figure out what the kid needed to feel more stable, so that they could work on what all adolescents should be doing is learning about themselves, the world around them, and the skills needed to be an adult.

Occasionally, when I met someone new and they learned what I do, they would ask if there was a common denominator for why a kid would be in crisis. There were all sorts of things that would contribute to a kid struggling. We know the list: poverty, abuse, addiction, mental illness, abandonment, asking them to be adult too young.

On thing that stood out was that the kids who had family dinners semi-regularly with out TV had more resilience, more self-insight, more age appropriate skill. Dinners are a place where information can be shared which helps kids learn about the world that they have yet to experience. It is also a place for the kid to articulate who they are.

Poverty is not a choice. It is a cycle. Understanding the cycle and having path finders who have h escaped the cycle of poverty. In this podcast, Dr. Donna Beegle shares her story of marrying at 15 years old, supporting her two children without a high school diploma and at 26 years old learning that she could have another life. She started by getting her GED and made it to her Ph.D. Now she runs an organization that works to break the cycle of poverty. In the podcast, she also explains the different types of poverty and the barriers that keep people trapped.

One of my favorite podcasts is Open Account with SuChin Pak sponsored by Umpqua Bank. In the podcast world, you can find endless podcasts on world you can find podcasts that tell you what to do with money but it is rare to find one that interview people to find the common experiences with money. In her words, she “searches for answers about why money is so universally thrilling, confusing, powerful, and stressful through personal stories with people that inspire us to think big, and think together, about money— no matter how much, or how little, you have.”

Here are update photos of the "Hangry Cart" in Mason County. Food Lifeline provides lunch bags to parents in dependance courts so that their can function better.

As Ambrosia a Parent Ally in Spokane County who promotes protein for parents on their worst day just said to me. "When we eat protein, our brains can become solution oriented."

In Spokane, their food cart is funded my protein ferries. Individuals working in the Dependancy court system just buy and drop onto the cart a box of bars. The parent allies suspect that it is the lawyers both from the Attorney General's office and the defense attorneys. Who ever the protein ferries are they are contributing because it benefits a person in need and themselves. It is just easier to have complex emotional conversations when the person has a brain the is fueled.

Who does not live in a complex world these days? No matter who I talk with the information age has increased the complexity of work, leadership, family life, and health. The question is not “How do we decrease the complexity?”, but more , “How do we increase the resilience?”

Since 2014, I have been working with an amazing team at the Court Improvement Training Academy (CITA) at the University of Washington in Seattle. Lead by Robert Wyman and Kelly Warner-King, we have been listening, discussing, and offering trainings to one of the most complex systems - Child Welfare.

Rob and Kelly recently published an article on “Building Resilience Oriented Child Welfare System in The Juvenile and Family Court Journal" published by the National Council of Juvenile and Family Court Judges Association, in their March 1, 2017, Special Issue: Rethinking Foster Care. If you are interested in changing the child welfare system, please read the article. It offers insights and structures to improve not only children’s lives but also the people who work on the front lines of poverty, addiction, poor education, and lack of social support.

The article suggests that resilience is the goal in a system that involves complex decision making. We know that without resilience a system becomes brittle, lacking responsiveness and innovation. In their pyramid of resilience, the base is self-care of personal health. Second, you establish an environment of civility which is to care about system and community health. Third, you set up a trauma responsive court so that further harm is prevented. Another way of explaining this tier is that you understand what behaviors are counterproductive and you seek to stop them. The fourth tier of resilience is creating avenues of healing such as Peacemaking Courts. In other systems, I think of this tier as establishing what your most productive behaviors are and creating incentives to have them happen. Now at the top of the pyramid you have the ability to have generative capacity. You know that you have reach this optimal place when people are energized to work in the complexity. Individuals have the capacity to grow and thrive despite the stress of continual change. As a scientist, what I love about the frame is that at each level there are tools to measure success. This means that it can be studied and developed on a broader scale for not only child welfare, but for other complex systems such as business, non-profits, and government.